Atlas S J, Deyo R A, Keller R B, Chapin A M, Patrick D L, Long J M, Singer D E
Medical Practices Evaluation Center, Massachusetts General Hospital, Harvard Medical School, Boston, USA.
Spine (Phila Pa 1976). 1996 Aug 1;21(15):1787-94; discussion 1794-5. doi: 10.1097/00007632-199608010-00012.
A prospective cohort study of patients with lumbar spinal stenosis recruited from the practices of orthopedic surgeons and neurosurgeons throughout Maine.
To assess 1-year outcomes of patients with lumbar spinal stenosis treated surgically or nonsurgically.
No randomized trials and few nonexperimental studies have compared surgical and nonsurgical treatment of patients with lumbar spinal stenosis. The authors' goal was to assess 1-year outcomes of patients with lumbar spinal stenosis treated surgically or nonsurgically.
Eligible, consenting patients participated in baseline interviews and were then mailed follow-up questionnaires at 3, 6, and 12 months. Clinical data were obtained from a physician questionnaire. Outcomes included patient-reported symptoms of leg and back pain, functional status, disability, and satisfaction with care.
One hundred forty-eight patients with lumbar spinal stenosis were enrolled, of whom 81 were treated surgically and 67 treated nonsurgically. On average, patients in the surgical group had more severe imaging findings and symptoms and worse functional status than patients in the nonsurgical group at entry. Few patients with mild symptoms were treated surgically, and few patients with severe symptoms were treated nonsurgically. However, of the patients with moderate symptoms, a similar percent were treated surgically or nonsurgically. One year after study entry, 28% of nonsurgically and 55% of surgically treated patients reported definite improvement in their predominant symptoms (P = 0.003). For patients with moderate symptoms, outcomes for surgically treated patients were also improved compared with those of nonsurgically treated patients. Surgical treatment remained a significant determinant of 1-year outcome, even after adjustment for differences between treatment groups at entry (P = 0.05). The maximal benefit of surgery was observed by the time of the first follow-up evaluation, which was at 3 months. Although few nonsurgically treated patients experienced a worsening of their condition, there was little improvement in symptoms and functional status compared with study entry.
At a 1-year evaluation of patient-reported outcomes, patients with severe lumbar spinal stenosis who were treated surgically had greater improvement than patients treated nonsurgically. Comparisons of outcomes by treatment received must be made cautiously because of differences in baseline characteristics. A determination of whether the outcomes observed persist requires long-term follow-up.
一项前瞻性队列研究，研究对象为从缅因州各地骨科医生和神经外科医生的诊所招募的腰椎管狭窄症患者。
评估接受手术或非手术治疗的腰椎管狭窄症患者的1年预后情况。
尚无随机试验，非实验性研究也很少对腰椎管狭窄症患者的手术和非手术治疗进行比较。作者的目标是评估接受手术或非手术治疗的腰椎管狭窄症患者的1年预后情况。
符合条件且同意参与的患者接受了基线访谈，随后在3个月、6个月和12个月时收到随访问卷。临床数据通过医生问卷获得。预后指标包括患者报告的腿部和背部疼痛症状、功能状态、残疾情况以及对治疗的满意度。
共纳入148例腰椎管狭窄症患者，其中81例接受手术治疗，67例接受非手术治疗。平均而言，手术组患者在入组时的影像学表现和症状比非手术组患者更严重，功能状态更差。症状较轻的患者很少接受手术治疗，症状严重的患者很少接受非手术治疗。然而，在症状中等的患者中，接受手术或非手术治疗的比例相近。研究入组1年后，28%接受非手术治疗的患者和55%接受手术治疗的患者报告其主要症状有明显改善（P = 0.003）。对于症状中等的患者，与接受非手术治疗的患者相比，接受手术治疗的患者预后也有所改善。即使在对入组时治疗组之间的差异进行调整后，手术治疗仍然是1年预后的一个重要决定因素（P = 0.05）。在首次随访评估时，即3个月时，观察到了手术的最大益处。虽然很少有接受非手术治疗的患者病情恶化，但与研究入组时相比，症状和功能状态几乎没有改善。
在对患者报告的预后进行1年评估时，接受手术治疗的重度腰椎管狭窄症患者比接受非手术治疗的患者改善更大。由于基线特征存在差异，必须谨慎比较接受不同治疗的患者的预后情况。要确定观察到的预后情况是否持续存在，需要进行长期随访。
